Most people seem to know what a vasectomy is—but do you remember where you learned what it is? For most people, I find the answer is “no.” It’s just part of general knowledge that most adults in Britain seem to have, that vasectomy is a minor surgical procedure to sterilise men, and that it can sometimes be reversible. Other contraceptive knowledge that most adults are likely to have some idea of in Britain would be, for example: when abortion was legalised (1967 for England, Scotland and Wales; last year in Northern Ireland); that the Pill became widespread in the 1960s; that there were health issues with the early IUDs; and that women have had to fight for their rights to control their reproduction for the best part of a century. But do you know when vasectomies became available on the NHS? Or when the first one was performed? Do you know that there were backlashes against it? Typically, the answer is again no, and that’s where I come in.
I’m doing my PhD on the “Social History of Vasectomies in Britain,” looking at how this sterilising procedure went from being invented in the 1850s, to being considered illegal in the 1930s and 1940s, to being provided widely on the NHS in 1974, to being “general knowledge” now. Buckle up—and men, you may want to cross your legs.
To give a little background before the juicy bits, vasectomy first came about through testing on dogs as an alternative to castration, and then was performed on humans from the 1880s onwards. That’s before effective anaesthetic (patients likely had cocaine, opium and alcohol to dull the pain), and before proper hygiene practices and antibiotics. It didn’t take off quickly.
There was little understanding of exactly what would happen when the vas deferens was severed at the time, but it was thought that on reabsorbing the sperm (this does happen), the body would get extra “life force” and a man would have more energy or have any erectile dysfunction cured (this does not happen). A partial vasectomy—where they cut and cauterise or tie one vas deferens but the other is left intact—was thought to cure impotency by, I guess, making the remaining teste extra powerful? Anyway, these were generally theoretical ideas, and not carried out much in practice.
In fact, the first boost to vasectomy rates was through very different, and unsettling, circumstances. In 1899, the first vasectomy for non-medical reasons was performed in the USA, by Dr Sharp in an Indiana prison, on a 19-year-old inmate. Dr Sharp would go on to vasectomise almost 500 inmates before Indiana brought in official eugenic sterilisation legislation in 1907; other states followed suit soon after, and by the 1920s, thousands of American men had been sterilised with dubious consent in prisons, mental hospitals, and other institutions.
Britain never had such legislation, but that doesn’t mean there weren’t supporters. The first time vasectomy was really discussed in parliament or in medical journals was in calls to allow eugenic sterilisation of disabled people, pushed by the British Eugenics Society (BES) and its supporters.
Although they were not successful in their campaign, there is still evidence of eugenic sterilisation being performed in the UK: I have found evidence in the Ministry of Health archives of three boys and young men being castrated in a UK institution for eugenic means; the doctor involved was told not to do it again, and agreed not to, although there was no mention of what happened to the victims. (At this time there was also a very odd debate over whether any vasectomy would count as unlawful wounding, as it wasn’t medically necessary… this is a very niche medicolegal debate, so I will spare you the details.)
The Second World War, and the widespread knowledge of the Nazis’ eugenics programme, put an end to the British Eugenics Society, but not to their ideas. Several of the board members, especially a Dr Carlos Paton Blacker who had been General Secretary of the BES, were passionate about continuing the goal of making sterilisation a widely accessible option (seems good to me), especially for marginalised and poor people to ensure they don’t procreate and put extra strain on the state (not so good). They became involved in the Simon Population Trust in the 1960s, a charitable institution aimed at tackling overpopulation concerns which was based in the offices of the BES until 1965, then in the offices of the International Planned Parenthood Foundation. Dr Blacker became the Trust’s Chair, providing a direct link between the less popular eugenic movement and the more popular population control campaigns.
The Trust was interested in providing options more favourable than abortions—especially to the poor Catholic populations in many British cities who would fundamentally reject abortion and many contraceptive methods. Sterilisation seemed the answer. Male sterilisation, to be specific, as female sterilisation requires more intensive and risky surgeries, and may allow women to engage in promiscuity without the risk of pregnancy, which was a significant concern for those involved in the campaign.
The Population Bomb by German physician Paul Erhlich was published in 1968, which introduced an overpopulation zeitgeist—suddenly the western world was intensely concerned about the social, political, economic and environmental impact of overpopulation. Governments throughout the developed world were discussing population control measures, especially of populations in the Global South.
It is within this overpopulation crisis that the Simon Population Trust set up a vasectomy clinic in Crediton, Devon, called the Crediton Project. The first devoted vasectomy clinic in the UK, it ran privately since the surgery was not yet provided through the NHS. They saw thousands of patients in their first few years and gave general advice to doctors throughout the UK on providing their own vasectomy services.
The Trust conducted surveys of their patients as to, for example, whether they would recommend the surgery to others, and how they felt about it. The overwhelming majority were extremely happy with the results. Within these surveys, however, patients could also give the reason they opted for vasectomy and none—out of hundreds—responded to say they were doing it for either eugenic or overpopulation concerns. The eugenicists’ concerns were not reflected in the general public, who were choosing their contraceptive methods based on risk, convenience, gender parity (“if my wife had to give birth, this is the least I can do” is a recurring motif), and permanence. The big-picture ideas of social engineering and depopulation were just not clicking into the individualistic nature of contraceptive decision-making.
However, the Trust still saw a big breakthrough in 1974, when it was announced that vasectomy—along with all other major contraceptive methods—would be offered freely on the NHS. This was a huge step in seeing behaviour, especially sexual and familial behaviour, as a population-level public health matter. Before, it had often been argued that unless it was medically necessary (like a hysterectomy due to cancer), there was no need for the health service to provide contraception. This redefined sex and sexuality as part of the concern of the NHS and its doctors—something that many feminist historians understand to have been disempowering to women as their pregnancies and menstrual cycles became a biomedical issue to be “solved,” but in the case of vasectomy, was a huge step towards widespread provision.
From 1974 to the millennium, the story is one of steadily increasing popularity. There is no big moment in which vasectomy became popular—it just gradually climbed over the years. In my opinion, that is a big part of why we don’t know as much about it as female contraceptive choices and abortion: there are few big landmark moments, and there certainly weren’t men in the streets with placards demanding vasectomies. Rather, there has been a slow social shift towards seeing it as a viable option.
It’s not continuously on the up, though. From 2006 to 2016 there was a 64 per cent drop in vasectomies in England, and several health boards have been defunding their vasectomy services; part of this is as long-term reversible contraceptives like IUDs increase in popularity again, but it is still shocking that in many parts of the UK, it is no longer possible to get an NHS-funded vasectomy. As reversible options take over, and other potential options for men are trialled globally, the history of vasectomy may be a short one in the west.
I am currently conducting oral history interviews with men who got vasectomies in Britain before 1990—if that is you or anyone you know and you might be willing to chat to me, please get in touch at georgia.grainger@strath.ac.uk, or via twitter @sniphist.
I’m doing my PhD on the “Social History of Vasectomies in Britain,” looking at how this sterilising procedure went from being invented in the 1850s, to being considered illegal in the 1930s and 1940s, to being provided widely on the NHS in 1974, to being “general knowledge” now. Buckle up—and men, you may want to cross your legs.
To give a little background before the juicy bits, vasectomy first came about through testing on dogs as an alternative to castration, and then was performed on humans from the 1880s onwards. That’s before effective anaesthetic (patients likely had cocaine, opium and alcohol to dull the pain), and before proper hygiene practices and antibiotics. It didn’t take off quickly.
There was little understanding of exactly what would happen when the vas deferens was severed at the time, but it was thought that on reabsorbing the sperm (this does happen), the body would get extra “life force” and a man would have more energy or have any erectile dysfunction cured (this does not happen). A partial vasectomy—where they cut and cauterise or tie one vas deferens but the other is left intact—was thought to cure impotency by, I guess, making the remaining teste extra powerful? Anyway, these were generally theoretical ideas, and not carried out much in practice.
In fact, the first boost to vasectomy rates was through very different, and unsettling, circumstances. In 1899, the first vasectomy for non-medical reasons was performed in the USA, by Dr Sharp in an Indiana prison, on a 19-year-old inmate. Dr Sharp would go on to vasectomise almost 500 inmates before Indiana brought in official eugenic sterilisation legislation in 1907; other states followed suit soon after, and by the 1920s, thousands of American men had been sterilised with dubious consent in prisons, mental hospitals, and other institutions.
Britain never had such legislation, but that doesn’t mean there weren’t supporters. The first time vasectomy was really discussed in parliament or in medical journals was in calls to allow eugenic sterilisation of disabled people, pushed by the British Eugenics Society (BES) and its supporters.
Although they were not successful in their campaign, there is still evidence of eugenic sterilisation being performed in the UK: I have found evidence in the Ministry of Health archives of three boys and young men being castrated in a UK institution for eugenic means; the doctor involved was told not to do it again, and agreed not to, although there was no mention of what happened to the victims. (At this time there was also a very odd debate over whether any vasectomy would count as unlawful wounding, as it wasn’t medically necessary… this is a very niche medicolegal debate, so I will spare you the details.)
The Second World War, and the widespread knowledge of the Nazis’ eugenics programme, put an end to the British Eugenics Society, but not to their ideas. Several of the board members, especially a Dr Carlos Paton Blacker who had been General Secretary of the BES, were passionate about continuing the goal of making sterilisation a widely accessible option (seems good to me), especially for marginalised and poor people to ensure they don’t procreate and put extra strain on the state (not so good). They became involved in the Simon Population Trust in the 1960s, a charitable institution aimed at tackling overpopulation concerns which was based in the offices of the BES until 1965, then in the offices of the International Planned Parenthood Foundation. Dr Blacker became the Trust’s Chair, providing a direct link between the less popular eugenic movement and the more popular population control campaigns.
The Trust was interested in providing options more favourable than abortions—especially to the poor Catholic populations in many British cities who would fundamentally reject abortion and many contraceptive methods. Sterilisation seemed the answer. Male sterilisation, to be specific, as female sterilisation requires more intensive and risky surgeries, and may allow women to engage in promiscuity without the risk of pregnancy, which was a significant concern for those involved in the campaign.
The Population Bomb by German physician Paul Erhlich was published in 1968, which introduced an overpopulation zeitgeist—suddenly the western world was intensely concerned about the social, political, economic and environmental impact of overpopulation. Governments throughout the developed world were discussing population control measures, especially of populations in the Global South.
It is within this overpopulation crisis that the Simon Population Trust set up a vasectomy clinic in Crediton, Devon, called the Crediton Project. The first devoted vasectomy clinic in the UK, it ran privately since the surgery was not yet provided through the NHS. They saw thousands of patients in their first few years and gave general advice to doctors throughout the UK on providing their own vasectomy services.
The Trust conducted surveys of their patients as to, for example, whether they would recommend the surgery to others, and how they felt about it. The overwhelming majority were extremely happy with the results. Within these surveys, however, patients could also give the reason they opted for vasectomy and none—out of hundreds—responded to say they were doing it for either eugenic or overpopulation concerns. The eugenicists’ concerns were not reflected in the general public, who were choosing their contraceptive methods based on risk, convenience, gender parity (“if my wife had to give birth, this is the least I can do” is a recurring motif), and permanence. The big-picture ideas of social engineering and depopulation were just not clicking into the individualistic nature of contraceptive decision-making.
However, the Trust still saw a big breakthrough in 1974, when it was announced that vasectomy—along with all other major contraceptive methods—would be offered freely on the NHS. This was a huge step in seeing behaviour, especially sexual and familial behaviour, as a population-level public health matter. Before, it had often been argued that unless it was medically necessary (like a hysterectomy due to cancer), there was no need for the health service to provide contraception. This redefined sex and sexuality as part of the concern of the NHS and its doctors—something that many feminist historians understand to have been disempowering to women as their pregnancies and menstrual cycles became a biomedical issue to be “solved,” but in the case of vasectomy, was a huge step towards widespread provision.
From 1974 to the millennium, the story is one of steadily increasing popularity. There is no big moment in which vasectomy became popular—it just gradually climbed over the years. In my opinion, that is a big part of why we don’t know as much about it as female contraceptive choices and abortion: there are few big landmark moments, and there certainly weren’t men in the streets with placards demanding vasectomies. Rather, there has been a slow social shift towards seeing it as a viable option.
It’s not continuously on the up, though. From 2006 to 2016 there was a 64 per cent drop in vasectomies in England, and several health boards have been defunding their vasectomy services; part of this is as long-term reversible contraceptives like IUDs increase in popularity again, but it is still shocking that in many parts of the UK, it is no longer possible to get an NHS-funded vasectomy. As reversible options take over, and other potential options for men are trialled globally, the history of vasectomy may be a short one in the west.
I am currently conducting oral history interviews with men who got vasectomies in Britain before 1990—if that is you or anyone you know and you might be willing to chat to me, please get in touch at georgia.grainger@strath.ac.uk, or via twitter @sniphist.
